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MBBS 3: Surgery > Transfusion > Flashcards

Transfusion Flashcards

1
Q

What is transfusion?

A

a procedure in which whole blood or parts of blood are put in a patients bloodstream through a vein
- different pathologies require different treatments

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2
Q

Where is whole blood usually given?

A

much more commonly given in low- and middle- income countries (LMIC) than in high-income countries
* accounts for 30-40% of blood or blood products given in LMIC

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3
Q

What is whole blood?

A

blood as it comes from the donor
- It can be given “fresh,” or “frozen
Note: When frozen and stored, it can be kept for between 20 and 40 days

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4
Q

How much is 1 unit of whole blood?

A

450-500mL
- contains about 12-17 g/dL of hemoglobin
Note: on average, will increase the recipient’s hemoglobin by 1 g/dL
e.g. from 5.5 g/dL to 6.5 g/dL

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5
Q

What are the indications for the use of whole blood?

A
  1. replacement of acute blood loss
  2. exchange transfusion
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6
Q

How should whole blood be given?

A

one unit at a time
- In a setting where there is not active hemorrhage or shock

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7
Q

How should whole blood be given in terms of time intervals?

A

One unit should be transfused over a two hour period (maximum of 4 hours).
Note: For frail patients (>70 years old or substantial cardiac disease), the administration may be slower (3-4 hours).

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8
Q

Use of diuretics vs blood transfusion?

A

should be given before the blood
products to avoid the risks of fluid overload
Note: Diuretics should not be given to a patient with hemodynamic instability or shock

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9
Q

What are packed red blood cells?

A

are one component of whole blood in which the red blood cells are separated from the plasma component

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10
Q

How much is one unit of packed red blood cells?

A

300-350 mL of volume, with about 200-250 mL of that being red blood cells
Note: transfusion of 1 unit of PRBCs raises the recipient’s hemoglobin by about 1 g/dL or hematocrit by 3%.

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11
Q

Indications for giving packed red blood cells?

A
  1. bleeding
  2. anemia
    Note: caution should be used in the elderly and those with cardiac conditions
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12
Q

What are platelet concentrates?

A

platelets are separated from the plasma and other cellular
components

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13
Q

Describe the storage of platelets?

A

Platelets can only be stored for 5 days and must be shaken or agitated
while stored

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14
Q

How much is one unit of platelets?

A

Platelets are given as one unit (about 50-60 mL) for every 10 kg

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15
Q

Indications for giving platelets?

A
  1. bleeding due to thrombocytopenia
  2. platelet dysfunction
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16
Q

What is fresh frozen plasma?

A

Plasma is the component of whole blood that remains when the cellular
components are separated for other uses
- It includes all of the clotting factors as well as albumin and other blood
proteins

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17
Q

Describe the storage of plasma?

A

Plasma is stored frozen and can be used for up to one year.

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18
Q

What is one unit of FFP?

A

one unit is about 250-300 mL of volume
- generally given as a dose of 15 mL/kg

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19
Q

Indications for use of FFP?

A
  1. correction of clotting factor
    deficiencies
    - as evidenced by elevated PT (INR) or PTT (1.5 times normal).
  2. liver dysfunction or failure
  3. DIC
  4. isolated clotting factor deficiencies if the recombinant form of the factor is not available
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20
Q

What is blood screening?

A

prior to transfusion, that blood be screened for infection as well as for compatibility between the donor’s blood and the recipient
- compatibility is based on what antigens are present on the donor’s cells and what antibodies the recipient has

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21
Q

Major blood group antigens are?

A

A, B, and RhD
Note:
- red blood cells express antigens on their surface.
- Each person’s red blood cells express some combination of A and B antigens

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22
Q

Blood group A?

A
  1. red blood cell type - A
  2. antibodies in plasma - Anti-B
  3. Antigens in red blood cell - A antigen
23
Q

Blood Group B?

A
  1. red blood cell type - B
  2. antibodies in plasma - Anti-A
  3. antigens in red blood cell - B antigen
24
Q

Blood group AB?

A
  1. red blood cell type - AB
  2. antibodies in plasma - none
  3. antigens in red blood cell - A and B antigens
25
Q

Blood group O?

A
  1. red blood cell type - O
  2. antibodies in plasma - Anti-A and Anti-B
  3. antigens in red blood cell - none
26
Q

What are the minor blood group antigens on the surface of red
blood cells?

A

Duffy, C, D, E, Kidd, Kell
- reated from prior immunization from a transfusion or pregnancy
- cause less severe reactions than ABO

27
Q

What is crossmatching?

A
  • Crossmatching confirms that a specific, chosen unit of blood is compatible with the anticipated patient recipient.
  • Once a crossmatch has been performed, the chosen unit of blood can be used in the anticipated recipient.
  • This confirms that the donor of the blood and the recipient are compatible.
28
Q

Indications for transfusion?

A
  1. It should always be given in situations of acute blood loss with ongoing bleeding
  2. It is also indicated in situations of symptomatic anemia (dizziness, syncope, orthostatic hypotension, chest pain)
    - If the patient has symptoms, then transfusion for higher targets may be necessary.
    Note:
    - transfusion threshold of 7g/dL in order to maximize benefits while minimizing risks and adverse effects
    - A type/group and screen should be performed for hemoglobin less than 8 g/dL
29
Q

Complications of transfusion?

A

immune mediated
1. Acute Hemolytic Transfusion Reaction (1 in 40,000)
2. Febrile Non-hemolytic Transfusion Reaction (1 in 300 RBC / 1 in 20
platelets)
3. Allergic Reactions
4. Transfusion Related Acute Lung Injury (TRALI)
5. Transfusion-Associated Circulatory Overload (TACO)
6. Delayed Hemolytic Transfusion Reaction
Non-immune mediated
7. Bacterial sepsis
8. Blood-borne pathogens

30
Q

What is acute hemolytic transfusion rection?

A
  • reflects an incompatibility between the patient and the transfused blood
  • It results when a recipient has antibodies against the red blood cells in the transfused blood
  • Resulting in hemolysis of the transfused red blood cells
  • often due to clerical or lab based errors
31
Q

Acute hemolytic transfusion reaction presents with?

A
  1. fever (often the first and sometimes only sign),
  2. chills,
  3. nausea and vomiting,
  4. dyspnea,
  5. hemoglobinuria,
  6. back or flank pain,
  7. hypotension
  8. DIC (disseminated intravascular coagulation).
32
Q

Treatment of acute hemolytic transfusion reaction?

A
  1. The transfusion should be stopped immediately
  2. Treatment requires supportive care
  3. intravenous fluids to prevent renal
    failure
  4. treat hemoglobinuria
  5. treatment for DIC
33
Q

What is febrile non-hemolytic transfusion reaction?

A
  1. occurs due to cytokines released by leukocytes within the transfused blood
  2. recipient antibodies against donor leukocytes or human leukocyte antigens (HLAs)
34
Q

Presentation of febrile non-hemolytic transfusion reaction?

A
  1. fever
  2. chills
  3. nausea/vomiting
  4. hypotension
35
Q

Demographics of people who get febrile non-hemolytic transfusion reactions normally?

A
  1. people who have had multiple transfusions
  2. women who have had multiple pregnancies
36
Q

Diagnosis of febrile non-hemolytic transfusion reaction?

A

It is a diagnosis of exclusion, and other, life-threatening transfusion reactions must be ruled out

37
Q

Treatment of febrile non-hemolytic transfusion reaction?

A

paracetamol

38
Q

How do you identify an allergic transfusion reaction?

A

due to development of a rash

39
Q

How do you treat an allergic transfusion reaction?

A
  1. transfusion should be stopped after development of a rash
    - If the rash covers less than 2/3 of the body, and there are no other symptoms, then it is possible to restart the transfusion at a slower rate
  2. Minor reactions, known as urticarial reactions, may be treated with an antihistamine
40
Q

Describe anaphylaxis in transfusions?

A

(1 in 40,000 transfusions) can occur and is often unexplained

41
Q

Presentation of anaphylaxis?

A
  1. dyspnea
  2. cutaneous rash
  3. tongue or throat swelling
  4. anxiety
  5. hypotension.
42
Q

Treatment for anaphylaxis?

A
  1. The transfusion should be stopped and not restarted.
  2. Epinephrine should be available whenever and wherever transfusions are given.
43
Q

What is transfusion related acute lung injury?

A

donor antibodies attack recipient WBCS and pulmonary epithelium
> rapid onset lung injury and noncardiogenic pulmonary edema due to activation of immune cells in lungs
- a cytokine release in the pulmonary circulation occurs, resulting in small vessel change

44
Q

Presentation of TRALI?

A
  1. dyspnea
  2. hypoxia with a chest X-ray showing bilateral infiltrates, mimicking ARDS
  3. fever
  4. chills
45
Q

Treatment of TRALI?

A
  1. The transfusion should be stopped immediately
  2. Treatment is supportive, often requires mechanical ventilation, and resolves in 24-72 hours.
46
Q

What is transfusion associated circulatory overload?

A

pulmonary edema develops primarily due to volume excess or circulatory overload
- Fluid overload of the circulatory system occurs when the transfusion is rapid or when there is underlying cardiac dysfunction

47
Q

Presentation of TACO?

A
  1. dyspnea
  2. hypoxia with elevated jugular venous
    pressure and hypertension
48
Q

Presentation of TACO?

A
  1. dyspnea
  2. hypoxia with elevated jugular venous
    pressure and hypertension
49
Q

Treatement of TACO?

A
  1. The transfusion should be stopped.
  2. Supportive care with oxygen should be provided and diuretics should be administered
50
Q

What is delayed hemolytic transfusion reaction?

A

delaed reaction that ocurs days to weeks following transfusion characterized by mild anemia and/or hyperbilirubinemia
- it is possible to develop new fever and jaundice with an unexpected drop in hemoglobin due to hemolysis.

51
Q

What is bacterial sepsis?

A
  • results from bacterial contamination of the blood or blood product
  • most commonly occurs from the administration of platelets because they are stored at room temperature
52
Q

Presentation of bacterial sepsis?

A
  1. fever and rigors with tachycardia
  2. dyspnea
  3. hypotension
53
Q

Describe blood-borne pathogens in transfusions?

A
  • Infectious pathogens may be transmitted via blood transfusions.
  • Screening is mandatory for all transfused blood for HIV, Hepatitis B, Hepatitis C, malaria and syphilis

MBBS 3: Surgery (42 decks)

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